应用胰岛素泵治疗儿童及青少年1型糖尿病对糖代谢的影响

为观察应用胰岛素泵治疗儿童及青少年1型糖尿病(T1DM)对糖代谢的影响 ,随访10例胰岛素泵治疗的T1DM患儿 ,分别观察胰岛素泵治疗前、后6个月的糖化血红蛋白值(HbA1c)、胰岛素用量、严重低血糖及酮症酸中毒发生次数的变化情况。结果显示 ,胰岛素泵治疗6个月后HbA1c 显著下降 ,治疗前为8.97 %±1.69 %,治疗后为7.51 %±1.17 % (t=2.52 ,P<0.05) ;胰岛素用量无显著下降 ;未发生严重低血糖和酮症酸中毒。表明胰岛素泵治疗可有效控制血糖 ,明显降低HbA1c,减少低血糖及酮症酸中毒的发生 ,是儿童及青少年T1DM常规治疗的较好选择。     

应用胰岛素泵治疗儿童1型尿病合并酮症酸中毒

目的 探讨使用胰岛素泵持续皮下输注胰岛素治疗儿童１型糖尿病合并酮症酸中毒的可行性。方法 将在我院住院的１型糖尿病合并酮症或酮症酸中毒的患儿１２例,分为胰岛素泵治疗组和对照组,每组６例,分别使用胰岛素泵皮下输注胰岛素和小剂量胰岛素静脉滴注,常规胰岛素的用量为０．０５～０．１０ＩＵ／（ｋｇ．ｈ）,观察血糖、β－羟丁酸、尿酮体的变化,结果 ⑴两组患儿的血糖在使用量为０．０５～０．１０ＩＵ／（ｋｇ．ｈ）经     

胰岛素泵在1型糖尿病患儿的合理使用

目的 探讨胰岛素泵强化治疗对1型糖尿病(T1DM)患儿的疗效,并分析影响疗效和胰岛素用量的因素.方法 本院内分泌科2003-2008年收治的T1DM患儿68例.对其进行短期胰岛素泵强化治疗,将其分为初诊组和复诊组、感染组和非感染组,并酮症酸中毒(DKA)和非DKA组,观察影响使用胰岛素泵治疗效果的因素,在年龄、初诊、感染和并DKA等情况下胰岛素泵的使用情况.结果 68例患儿均予胰岛素泵强化治疗,血糖达标天数为(4.37±1.60) d,达标时胰岛素用量为(1.22±0.34) U/(kg·d);初诊组和复诊组血糖达标时间、胰岛素用量比较均无显著差异(Pa>0.05);非感染组达标时间明显均较感染组、并DKA组短(Pa<0.05);与非感染组比较,感染组、并DKA组基础胰岛素用量大(Pa<0.01),小年龄组胰岛素输注管堵塞和发生低血糖例次明显多于大年龄组儿童.结论 胰岛素泵的使用在T1DM患儿存在着差别,小年龄组胰岛素泵使用要慎重.     

胰岛素泵治疗儿童1型糖尿病酮症酸中毒32例临床分析

目的 观察胰岛素泵持续皮下注射胰岛素对儿童1型糖尿病酮症酸中毒(DKA)的疗效.方法 将2005-2008年收治的1型DKA患儿64例分为治疗组32例和对照组32例.治疗组予胰岛素泵治疗,对照组予小剂量胰岛素持续静脉滴注治疗.比较两组患儿血精变化、DKA纠正时间及住院时间.结果 治疗组血糖下降相对稳定,酸中毒纠正时间治疗组[(16.91±4.223)h]短于对照组[(23.31±3.797)h](P<0.001),且无反复.治疗过程中治疗组未出现低血糖,对照组出现1例.住院时间治疗组[(15.63±2.458)d]短于对照组[(20.88±3.348)d](P<0.001).结论 胰岛素泵持续皮下注射胰岛索治疗儿童1型糖尿病酮症酸中毒安全有效.     

儿童1型糖尿病胰岛素泵治疗长期随访的疗效观察

目的 比较1型糖尿病(T1DM)患儿应用持续皮下胰岛素输注(CSII)与每日多次皮下胰岛素注射(MDI)治疗对血糖控制的疗效差异.方法 回顾性收集91例应用CSII方式治疗1年以上T1DM患儿的临床资料,评估其糖化血红蛋白(HbA1C)水平、糖尿病酮症酸中毒(DKA)再发生情况,通过与75例应用MDI治疗的T1DM患儿...     

胰岛素泵治疗儿童1型糖尿病并酮症或酮症酸中毒26例

目的观察胰岛素泵持续皮下注射胰岛素对儿童1型糖尿病并酮症或酮症酸中毒(DK/DKA)的疗效。方法本院内分泌科2003~2005年收治的1型糖尿病并DK/DKA患儿43例,分为治疗组26例和对照组17例。治疗组予胰岛素泵治疗,对照组予小剂量胰岛素持续静脉滴注。比较二组患儿血糖、尿酮体、血pH值变化,住院时间长短。结果1.治疗组血糖下降相对稳定,纠正酸中毒后无反复。2.治疗过程中治疗组未出现低血糖,对照组2例出现。3.住院时间治疗组[(11.92±4.72)d]较对照组[(17.35±4.83)d]治疗组较对照组明显缩短(P<0.001)。结论胰岛素泵持续皮下注射胰岛素治疗儿童1型糖尿病并DK/DKA是安全有效的。     

持续皮下胰岛素输注在儿童1型糖尿病治疗中的应用

胰岛素泵(CSII)可减少严重低血糖、改善黎明现象、降低糖化血红蛋白(HbAlc),但花费大、有皮肤损害、活动时部分患者感觉不便。因此,需要更多、更经常和更严格的监测,进行糖尿病知识教育,掌握不当反而易发生糖尿病酮症酸中毒。建议选择适用患者为主动寻求降低血糖和HbAlc、寻求减少低血糖危险、寻求改善生活方式、愿意尝试CSII治疗和应有现实合理期望值的患者。同时他们应有良好的自我管理能力,按时随访,会计算碳水化合物,每日监测4次以上血糖,有可靠的成人监督,掌握CSII治疗的各项技术技能,能主动与糖尿病治疗专家沟通等。作者就1型糖尿病患儿CSII使用和调节剂量的方法进行介绍。     

儿童急性淋巴细胞白血病治疗失败原因分析

急性淋巴细胞白血病(ALL)是儿童时期最常见的恶性肿瘤之一,近年由于采用现代联合化疗,儿童ALL的治疗疗效显著提高,在发达国家中其5年无事生存率(EFS)已达80%[1,2].     

常规注射胰岛素和胰岛素泵治疗的1型糖尿病儿童主观生活质量及影响因素研究

目的调查常规注射和使用胰岛素泵输注胰岛素两种治疗方式下1型糖尿病患儿的生活质量并探讨影响患儿生活质量的相关因素。方法采用儿少主观生活质量问卷和父母养育方式评价量表,对42例1型糖尿病患儿、26例健康儿童进行评测,并对影响患儿生活质量的相关指标进行多因素回归分析。结果糖尿病患儿生活质量低于健康儿童,采用胰岛素泵治疗患儿在学校生活、抑郁体验、焦虑体验、情感成分以及总体满意度上优于常规注射治疗患儿(P均<0.05)。糖尿病患儿较正常儿童更容易得到父母的关心理解和情感温暖,更容易受到父母的过度保护,其生活质量与父亲的情感温暖、关心理解以及采用的治疗方式密切相关。结论1型糖尿病患儿生活质量下降客观存在,父亲多给予患儿情感温暖和采用胰岛素泵有助提高患儿生活质量。     

儿童青少年糖尿病强化治疗及门冬胰岛素的应用

儿童糖尿病首选胰岛素强化治疗的观点已被大多数儿科糖尿病专家所接受.其目的 是尽可能模拟正常机体生理胰岛素的分泌模式.但由于儿童患者生理发育及心理、文化和生活方式的特殊性,使方案的实际落实面临诸多困难.合理、安全并成功实现儿童患者良好血糖控制仍面临巨大的挑战.经过医药专家的多年努力,临床已经拥有能够模拟生理胰岛素分泌模式的医疗手段.文章就目前用于强化治疗儿童糖尿病的速效胰岛素和不同胰岛素注射方案的实际应用效果予以阐述.     

Life-threatening autoimmunity with diabetes: management with an insulin pump

Abstract:  A 2-yr-old boy presented initially with type 1 diabetes (T1D). Over the next 9 yrs, he developed multiple autoimmune conditions including Evans' syndrome, alopecia, and autoimmune bowel disease. Autoimmune polyendocrinopathy, candidiasis, ectodermal dystrophy (APECED) syndrome was considered, but no mutations were found in the autoimmune regulator-1 ( AIRE-1 ) gene, making this diagnosis unlikely, and he did not fulfil the clinical criteria for immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome. We describe the challenges created by the combination of these diseases and how introduction of insulin pump therapy revolutionized his care.     

Intraaortic balloon pump management of refractory congestive heart failure in children

Summary From December 1975 to September 1989, nine children, ages 0.6–15.8 years (mean=8.1 years) and weighing 5–44 kg (mean=24 kg), were identified as requiring intraaortic balloon pump support. Indications included ventricular failure refractory to maximal conventional therapy, inability to wean from cardiopulmonary bypass, and myocardial ischemia. Prior to insertion of the balloon catheter, mean systolic blood pressure was 64 mmHg, one to four cardiotonic medications were being administered, mechanical ventilation was being performed in eight patients, and mean urine output was 0.4 ml/kg/min in eight. Following balloon catheter insertion, mean urine output increased to 0.9 ml/kg/min. Four patients survived following discontinuation of the balloon catheter 12–96 h (mean=59 h) after initiation. Though complications such as loss of distal lower extremity pulses, sepsis, thrombocytopenia, and abdominal distention were observed, most could be attributed to other causes. Thus, the intraaortic balloon pump is a valuable addition to conventional medical therapy in the treatment of refractory cardiogenic shock in children.Presented in part at the American Academy of Pediatrics Annual Meeting, Boston, Massachusetts, October 6, 1990.     

The use of insulin pump therapy in adolescents

Continuous subcutaneous insulin infusion (CSII) systems have been used in diabetes management since the mid-1970s. Investigators have reported encouraging results with CSII use in adult subjects with dramatically improved glucose control, reversal of some complications, and high acceptance and compliance rates. We have studied 10 adolescents and 3 young adults using CSII for diabetes management. Only the three young adults (ages 20, 24, 34 years) have had markedly improved metabolic control, sustained pump use, and made adequate psychological adjustment to CSII therapy. Adolescent subjects, (ages 9-17 years), experienced problems with peer acceptance of pumps, had difficulty with infusion needle insertion and skin care, were unable to perform home blood glucose monitoring consistently, made nonadvised manipulations of insulin dosage and reported mechanical problems with CSII devices more frequently than the young adult subjects. Mean duration of CSII use in adolescent subjects (6.1 months) was significantly less than mean use (30.6 months) among the young adults (p less than 0.01). Currently, adults appear to have greater success than adolescents in using CSII for diabetes management.     

Neonatal diabetes and insulin pump therapy

The need for delivery of small doses of insulin, together with unpredictable feeding patterns and frequent changes in nutrient intake, makes the management of neonatal diabetes challenging. The availability of continuous glucose monitoring systems in combination with continuous subcutaneous insulin infusion pumps provides an opportunity to monitor glucose levels more closely and deliver insulin more safely. We report on a preterm infant with neonatal diabetes who had profound hypoglycaemia in response to bolus subcutaneous insulin therapy, but in whom we used the combination of continuous glucose monitoring and insulin pump therapy to manage glucose control in the neonatal period, and who was discharged home on pump therapy.     

Nutritional management of children and adolescents on insulin pump therapy - a survey of Australian Practice

Objective:  The aims of the survey were to review nutritional care provided to children on insulin pump therapy (IPT) and to identify areas of consensus in medical nutrition therapy. Interventions were compared with existing evidence for best practice.
Method:  A questionnaire was sent to Dieticians in tertiary pediatric diabetes centers in Australia. Data were gathered on clinic demographics, reasons for commencement of pump therapy, and time spent in medical nutrition therapy. Details of nutrition education strategies were identified. Outcomes from nutrition interventions were reported.
Results:  A 100% response rate was achieved (n = 12). A number of nutrition therapy interventions were provided to children on IPT. These included carbohydrate counting, glycemic index (GI), and carbohydrate exchanges. At most centers, nutrition education involved teaching dose adjustment for meals based on the carbohydrate content of the meal with estimations to within 5 g. All centers taught GI. The format of nutrition education, including number and length of consults, varied greatly between centers. Only one center had developed nutrition guidelines for managing insulin pump patients.
Conclusions:  Most pediatric diabetes centers in Australia did not follow nutrition guidelines for the management of children on IPT. There were inconsistencies in the number and length of nutrition consultations provided. Some strategies employed in nutrition education were not supported by existing guidelines for best practice. Differences between centers highlighted gaps in the evidence for nutrition therapy interventions in children on pumps.     

The role of surgical placement and pump orientation in intrathecal pump system failure: a technical report

Intrathecal pump catheter complications are the most common cause of failure in drug delivery. A previous report has documented that intra-abdominal positioning of the intrathecal pump may predispose the pump-catheter neck to premature catheter breakdown and leakage. Based on this report, we reviewed over 100 intrathecal pump cases to determine the frequency of malpositioning and its role in the pathogenesis of catheter failure. We found three specific cases where a 'fulcrum effect' occurred due to intra-abdominal positioning of the pump predisposing the catheter to breakdown. This study demonstrates that intra-abdominal placement of the pump can predispose the catheter to failure/breakdown and that surgeons should attempt to place the pump catheter neck in a superiomedial position, distant from any bony prominences, to prevent the 'fulcrum effect' on the pump-catheter neck junction and reducing the likelihood of either internal or external compressive forces.